A Case of Neurotrophic Keratopathy Associated with Nasopharyngeal Carcinoma

Purpose: To report a case of neurotrophic keratopathy associated with nasopharyngeal carcinoma. Case Report: A 59-year-old man who had been diagnosed with a nasopharyngeal carcinoma was referred to the authors because of visual disturbance and pain in his right eye. Slit-lamp examination revealed a corneal epithelial defect and corneal stromal edema surrounding the epithelial defect area in his right eye. Magnetic resonance imaging showed a mass in his cavernous sinus, which was identified as nasopharyngeal carcinoma (NPC). We diagnosed neurotrophic keratopathy associated with NPC and initiated treatment with preservative-free artificial tears, antibiotic eye drops, fibronectin, a therapeutic contact lens, and amniotic membrane transplantation. However, the persistent corneal epithelial defect was unresponsive to these treatments. Conclusion: Neurotrophic keratopathy secondary to NPC is thought to be rare. We presented a case of neurotrophic keratopathy associated with cavernous sinus metastasis of an NPC. The development of new and more effective treatments for this refractory disease is anticipated.
Case Rep Ophthalmol 2018;9:114–118

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Race and ethnicity have significant influence on fractional exhaled nitric oxide

Publication date: Available online 15 February 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Dong Wang, Yanning Wang, Hong Liang, John E. David, Christopher L. Bray
BackgroundRace and ethnicity have been shown to influence fractional exhaled nitric oxide (FeNO). There is a need to investigate cutoff points for different races and ethnicities to improve clinical application.ObjectiveTo investigate cutoff points for different races and ethnicities by analyzing the FeNO data collected by the National Health and Nutrition Examination Survey from 2007 to 2012.MethodsThis study included 23,433 participants. After excluding participants with confounding factors, 11,084 participants were eligible for data analysis. Based on age and the probability of having allergic airway inflammation, participants were divided into 4 groups. The geometric mean and 5th, 50th, and 95th percentiles of FeNO in Hispanic, white, black, and other races were analyzed in all groups.ResultsCompared with white participants, the geometric mean for FeNO in black participants was 36% to 41% higher in children and 5% to 8% higher in adults. Hispanic children had significantly higher FeNO values (14% to 19%) compared with non-Hispanic white children; however, those differences were not significant in adults. Other races had significantly higher FeNO values in children (24–54%) and adults (9–29%) compared with white participants. Further, for normal healthy black children, the 95th percentile was 40.2 parts per billion (ppb), which is significantly higher than the cutoff point recommended by current guidelines.ConclusionAlthough there are significant differences in FeNO values among races and ethnicities, the current cutoff point at 50 ppb is sufficient to separate healthy from asthmatic populations in adults. However, for black children, we suggest increasing the cutoff point from 35 to 40 ppb to avoid unnecessary diagnosis and treatment.



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A review of cutaneous manifestations within glucagonoma syndrome: necrolytic migratory erythema

Abstract

Necrolytic migratory erythema (NME) is a rare skin disorder that is a cutaneous manifestation of the glucagonoma syndrome. It presents with annular eruptions of migrating erythematous papules and plaques with superficial epidermal necrosis, central flaccid bullae, and crusted erosions located primarily in the intertriginous areas. Treatment with the long-acting somatostatin analog Octreotide is a potential therapy to help ameliorate skin symptoms. We present a case of a patient with a 1-year history of a pancreatic glucagonoma that developed an ulcerated, plaque-like, weeping rash over multiple areas of their body despite current treatment with Octreotide and stable pancreatic tumor staging. The patient had a similar rash when initially diagnosed with a glucagonoma, and it quickly improved after Octreotide treatment. Clinical examination and biopsy were consistent with necrolytic migratory erythema due to an underlying glucagonoma. This rare case adds to our understanding of the clinical presentation of NME, as well as highlights the relapsing and remitting course, even if the underlying pancreatic tumor is stable and the patient is undergoing treatment.

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Linear yellow papules following a cat scratch

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Chimeric antigen receptors with human scFvs preferentially induce T cell anti-tumor activity against tumors with high B7H6 expression

Abstract

B7H6 is emerging as a promising tumor antigen that is known to be expressed on a wide array of tumors and is reported to stimulate anti-tumor responses from the immune system. As such, B7H6 presents a good target for tumor-specific immunotherapies. B7H6-specific chimeric antigen receptors (CAR) based on a murine antibody showed successful targeting and elimination of tumors expressing B7H6. However, mouse single chain variable fragments (scFvs) have the potential to induce host anti-CAR responses that may limit efficacy, so human scFvs specific for B7H6 were selected by yeast surface display. In this study, we validate the functionality of these human scFvs when formatted into chimeric antigen receptors. The data indicate that T cells expressing these B7H6-specific human scFvs as CARs induced potent anti-tumor activity in vitro and in vivo against tumors expressing high amounts of B7H6. Importantly, these human scFv-based CARs are sensitive to changes in B7H6 expression which may potentially spare non-tumor cells that express B7H6 and provides the foundation for future clinical development.

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Factors predictive of the onset and duration of action of local anesthesia in mandibular third-molar surgery: a prospective study

The aim of this study was to assess the influence of patients' and surgical variables on the onset and duration of action of local anesthesia (LA) in mandibular third-molar (M3) surgery. Patients scheduled for mandibular M3 surgery were considered for inclusion in this prospective cohort study. Patients' and surgical variables were recorded. Two per cent (2%) lidocaine with 1:100,000 epinephrine was used to block the nerves for extraction of mandibular M3. Then, the onset of action and duration of LA were monitored. Univariate analysis and multivariate regression analysis were used to analyze the data. The final cohort included 88 subjects (32 men and 56 women; mean age ± SD = 29.3 ± 12.3 yr). With univariate analysis, age, gender, body mass index (BMI), smoking quantity and duration, operation time, and 'volume of local anesthetic needed' significantly influenced the onset of action and duration of LA. Multivariate regression revealed that age and smoking quantity were the only statistically significant predictors of the onset of action of LA, whereas age, smoking quantity, and 'volume of local anesthetic needed' were the only statistically significant predictors of duration of LA. Further studies are recommended to uncover other predictors of the onset of action and duration of LA.

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Evaluation of an Abutment-level SuperPower Sound Processor for Bone-Anchored Hearing

Abstract

Objectives

Performance of an abutment-level superpower sound processor for bone-anchored hearing, the Ponto 3 SuperPower from Oticon Medical (BCD2), was compared to an earlier model from Oticon Medical (BCD1).

Design

A comparative study in which each patient serves as its own control.

Setting

Tertiary clinic.

Participants

Eighteen experienced BCD1 users with profound mixed hearing loss.

Main outcome measures

speech reception thresholds in noise; APHAB and SSQ questionnaires.

Results

In a group of 18 patients with severe mixed hearing loss the performance of a recently introduced bone conduction device (BCD2) is evaluated relative to that of an earlier model (BCD1). Speech reception thresholds for the sentence-in-noise test in the speech and noise frontal condition are not significantly different (p>0.05) for BCD1 and BCD2. Speech reception thresholds for frontal speech and three identical noise sources are 1.7 dB lower for BCD2 than for BCD1 (p<0.05).

With the APHAB questionnaire the score for background noise is significantly lower (p<0.01), i.e. more favourable, for BCD2 than for BCD1 with an effect size of 0.91. The APHAB domain scores for ease-of-communication, reverberation, and aversiveness of loud sounds are not significantly different for both devices (p>0.05). Scores for the speech, spatial, and quality of hearing domains of the SSQ questionnaire are significantly higher (p<0.01), i.e. more favourable, for BCD2 than for BCD1 with effect sizes of 1.22, 0.71, and 1.05, respectively. Scores for the SSQ-factors "speech understanding", "spatial", "clarity, separation and identification", and "listening effort and concentration" were all significantly higher (p<0.05) for BCD2 than for BCD1, with effect sizes of 1.28, 0.64, 0.98, and 0.78, respectively. On a proprietary questionnaire 16 patients indicate a preference for BCD2 over BCD1 for conversations in a small group and two patients have no preference for either device. In a large group one patient prefers BCD1, six patients have no preference and eleven patients prefer BCD2. When listening to music all patients prefer BCD2 over BCD1, with a strong preference for BCD2 for seven patients. When asked for an overall preference, all patients prefer BCD2 over BCD1, with nine patients strongly preferring BCD2.

Conclusions

The lower speech reception thresholds in noise with BCD2 relative to BCD1 can be attributed to the 'speech-omni' directionality mode of BCD2. The combination of an improved directionality for primarily low-level inputs and a higher maximum force output, relevant for mid and high-level inputs, results in a clear preference for BCD2 over BCD1.

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